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Pain during intercourse is a problem each day, women from all around the world are forced to deal with. In medical terms, pain during intercourse is called dyspareunia, a condition that can be treated after seeking medical advice. Dyspareunia or pain during intercourse is manifested by different sensations of discomfort or pain, that appear and disappear during intercourse or even after. When the pain is not so intense it only affects the vulva and the opening of the vagina.

There are many types of pain namely:

Primary pain during itercourse- appears after the first intercourse;
Secondary pain during intercourse – appears after a certain period, the woman had a sexual relationship but the pain is caused by psychological trauma;
Superficial pain during intercourse- appears at the beginning of penetration;
Deep pain during intercourse – occurs when the penetration is complete.
Superficial pain during intercourse is manifested by early discomfort, at the beginning of the intercourse, discomfort felt in the vulva, with burning and stinging sensations. The causes are vaginal infections, irritation, trauma, radiation therapy and in most of the cases insufficient lubrication.

Causes of Pain During Intercourse

There are many possible causes that can leat to pain during intercourse, which vary depending on the nature of the disease.

The superficial causes of pain during intercourse are:

Lubrication failure – due to a short prelude, for women who have passed to menopause due to the low estrogen levels;
An inflammation or infection in the genital area – they can affect the vulva or vagina
Urinary tract infections;
Genital herpes
Allergic reactions to latex condoms;
Surgery;
Antihistamines (drugs against allergies) – causes temporary dryness of the vagina;
Menopause – one of the most common causes as vaginal thinning and estrogen level decrease (this phenomenon is called atrophic vaginitis care)
Profound causes of pain during intercourse
Infection or inflammation of the cervix (cervicitis), uterus or fallopian tubes
Endometriosis (inflammation of the uterus);
Pelvic tumors;
Ovarian cysts;
Uterine prolapse;
Radiation – used in cancer treatment.
Psycho-social causes of pain during intercourse

The psycho-social causes of pain during intercourse are special cases, except those specific to each type of dyspareunia. Most women who have been victims of sexual abuse usually suffer from pain during intercourse. Moreover, these women may suffer from vaginismus. Vaginismus is a condition that is manifested by involuntary spasms of the vagina, making penetration painful or impossible. Fear, anxiety, fear of pregnancy, religious considerations – are all factors that may prevent arousal and lubrication, hence the pain that can sometimes be unbearable. Marital and psychological problems such as depression are common causes of pain during intercourse, that of erectile dysfunction. Women whose partners are distant or negligent have a normal reaction by the lack of sexual attraction to partners, while men in similar situations, may experience erectile dysfunction and even impotence.

All these factors must be made aware at first through a personal evaluation of the situation made by the person concerned, then by a discussion with a specialist. Untreated in time, pain during intercourse will make sexual activity to be associated strictly with pain, and interest in intercourse would drop dramatically.

Pain During Intercouse Treatment

Mild pain during intercourse, which usually occurs during penetration can be minimized by applying an ointment with anesthetic effect. It is also helpful to apply a water based lubricant before intercourse. Why water-based lubricants? Because oil-based ones can affect the quality of contraceptives such as condoms or diaphragms. For better lubrication of the vagina, enough attention to foreplay and deep pain can be lessened or eliminated by careful choice of positions during intercourse.

Pain during intercourse due to menopause and all that implies it can be treated with estrogen-based creams ( hormone replacement therapy). Inflammation and / or an infection is treated using antibiotics or antifungal drugs. In case of inflammation of the vulva, , wet compresses with aluminum acetate solution are verry effective. Surgery removes cysts or abscesses and can even repair some anatomical abnormalities relieving the pain during intercourse.

Last but not least, couple psychotherapy can be very effective in identifying negative or pessimistic attitudes about intercourse and improve communication between the couple, thus solving the problems that can cause the appearance of pain during intercourse.

• The appearance of blisters or pimples, which may burst and discharge clear fluid, blood or pus.

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Other infections, such as in­fection caused by chlamydia and gonorrhoea, are less common, but can lead to inflammation of the cervix and the pelvic organs, causing deep dyspareunia.

If an infection is suspected, a full check-up at a sexual health clinic (sexually transmitted infection/STI or special clinic) will be necessary. The appropriate treatment can then be prescribed.

As a general rule it is best to avoid washing the genital area with anything other than water because soaps, shower gels, bubble baths and disinfectants strip the vagina of healthy bacteria and allow other forms of infection to take hold.

Sex may be painful for a while even after the infection has cleared, because of remaining inflammation and reduced lubrication.

Postnatal or postsurgical problems (superficial or deep):
The shape of the vagina may be al­tered after giving birth, partic­ularly if the vagina was torn or cut, and then stitched. The scar that forms may not stretch as much as the rest of the vagina, making sex painful.

Women can resume intercourse after birth as soon as they wish, and as soon as tears or episio­tomies have healed. Some women resume as early as two weeks after delivery, although others prefer to wait till their first post­natal check. Women may find their libido changed (either increased or decreased) and that sex feels quite different compared to be­fore they were pregnant, because of the stretching of the vaginal muscles.

The vaginal area may also be affected by operations for incon­tinence or vaginal prolapse. In some cases it may be possible for the surgeon to refashion scarred areas to allow for easier intercourse.

Women who have pro­longed or vigorous intercourse or frequent intercourse (several times daily) may suffer pain during sex simply as a result of friction. Lub­rication with a water-based lubric­ant (e.g. KY Jelly) can help ease this problem, but it may be an idea to cut down on sex till it feels more comfortable. Remember also that oil-based lubricants (such as mas­sage oils, Vaseline, cooking oil, etc.) can damage rubber and lead to condom accidents.

Women also vary greatly in the amount of lubrication they pro­duce, even when sexually excited, and again the use of additional lubrication can make sex more comfortable.

Vaginal dryness and thinning of vaginal tissue is one effect of the menopause. Menopausal women should therefore use additional lubrication or consider hormone replacement therapy either locally to the vagina or for the whole body.

Having sex for the first time (superficial and/or deep):
Women having sex for the first time can find the experience painful, especially if the hymen has not been previously broken by tampons or other instruments. This is com­pounded by anxiety, lack of ex­perience (of both partners), lack of arousal and therefore lubrication, and clumsiness or forcefulness by the male partner.

Anxiety can be dealt with by the following:

• Having sufficient information about the sexual act

• Being prepared beforehand for the prevention of pregnancy and sexually transmitted infections (with a condom and the oral contraceptive pill for instance)

• Being relaxed with one’s sur­roundings and one’s partner

• Making sure there is plenty of lubrication before penile entry is attempted.

Lubricants (e.g. KY Jelly, from the pharmacist) can be used safely with condoms. Most oils (cooking oil, massage oil, Vaseline) break condoms.

It may help if penetration is attempted slowly, in stages, with the introduction of one finger, and then two, beforehand. It may take several episodes of intercourse for the woman to relax fully and be­come used to the sensation of having her vagina stretched by the penis.

Problems with the structure of the vagina or hymen (superficial):
Some women have a particularly small vaginal opening, which be­comes painful when stretched. In other women the hymen, which is normally torn during first inter­course, is stiff, and does not tear completely, giving rise to pain. Or it may split on two sides, leaving a hard band in the middle, which again makes sex uncomfortable. A few women have a ‘septate vagina’, in which their vagina is divided lengthways with a partition of tissue – this can of course lead to painful intercourse.

A physical examination by a doctor will rule out these unusual shapes, and in most cases simple surgery will rectify the problem.

Psychological causes:
As sex for women involves penetration, it is often important that it takes place in an atmosphere of relaxa­tion and trust. Any anxiety (about their own sexuality, pregnancy, the relationship, etc.) can lead to tens­ing of the vaginal muscles and pain­ful intercourse.

The woman may also become tense in response to a physical cause of pain, or a remembered trauma, e.g. childbirth or rape. Se­vere anxiety can lead to vaginismus which is discussed below. If a psychological cause is suspected, relationship or psychosexual coun­selling may be useful.

Vaginismus
Vaginismus is defined as uncontrollable tightening of the lower vaginal muscles, so that attempted penile entry is painful and im­possible. In some cases the thigh muscles clench as well, so that the partner is unable to get near the vagina.

Vaginismus can range from the ability to use tampons and toler­ate a vaginal examination but not to have sex, to the inability to touch or insert anything into the vagina without provoking the reaction.

Vaginismus is the most com­mon cause of non-consummation of marriage and is thought to oc­cur in about five of every thousand women, and makes up between 5 and 42 per cent of the sex thera­pist’s workload.

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Vaginismus may be caused by any of the reasons for painful sex listed above, if pain and anxiety are severe enough. It may occur after a traumatic experience of sex, such as rape or sexual abuse.

In cases where there are no obvious precipitants, and the wo­man has not experienced inter­course, vaginismus is usually the result of uncertainty and misin­formation about the sexual act and about female genitalia. There may also be deeply held religious be­liefs or the guilty view that sex and nakedness are ‘dirty’.

Vaginismus is best treated with the help of an understanding GP or a sex therapist.

A gentle examination is required to rule out physical problems. Once this has been done, the woman is encouraged to express her fears or fantasies about her body, proceeding to an exploration of her own genitalia. Her partner may be present if she so wishes.

Once she is aware of which muscles tense and how to relax them, the therapist will demon­strate that gentle insertion of a finger is possible. The woman is then encouraged to explore her vagina with her own fingers, or with ‘vaginal trainers’ of different sizes. The couple may then proceed to exercises in which the woman controls penile penetration, before full intercourse.

The outlook is extremely good, and sex therapists find this a re­warding condition to treat. In mild cases, only a few visits may be necessary, but in severe cases more sessions may be needed.

Nearly one in 10 British women finds sex painful, according to a large study.

The survey of nearly 7,000 sexually active women aged 16 to 74, in BJOG: An International Journal of Obstetrics and Gynaecology, suggests this medical problem – called dyspareunia – is common and affects women of all ages.

Women in their late 50s and early 60s are most likely to be affected, followed by women aged 16-24.

Doctors say there are treatments that can help if women seek advice.

But many still find the subject embarrassing and taboo, the survey results show.

Painful sex was strongly linked to other sexual problems, including vaginal dryness, feeling anxious during sex, and lack of enjoyment of sex.

However, there can be lots of different physical, psychological and emotional factors causing painful sex, which can be complex to treat.

Some women said they avoided intercourse because they were so afraid of the pain.

Karen (not her real name) is 62 and from Greater London. She said her problems began around the age of 40.

“I felt that my sex drive dipped quite considerably, arousal seemed to take longer, and, despite an understanding husband, I started to dread him making approaches.

“It’s like any muscle group I guess, the less you use it the worse it gets.”

Karen tried using lubricant but still encountered problems.

“It became like a vicious cycle. You worry and get tense and that only makes it worse.”

Karen developed another complication called vaginismus – involuntary tightening of the muscles around the vagina whenever penetration is attempted.

“It wasn’t just in bed. It happened when I needed smear tests too. I would be crawling up the bed away from the nurse because it hurt so much.”

Karen spoke to her doctor who recommended she try oestrogen creams and pessaries for the dryness and dilators to help with the involuntary tightening.

“Women need to know that there is help out there for these kinds of problems, especially as we are all living longer.

“You shouldn’t have to be writing off your sex life in your 50s.

“Many women don’t like to talk about it. We share all the gore of childbirth, yet women of my generation don’t tend to talk openly about sex and the menopause. We should.”

The national survey of sexual attitudes and lifestyles was carried out by the London School of Hygiene and Tropical Medicine (LSHTM), University College London and NatCen Social Research.

Of those who reported painful sex (7.5%), a quarter had experienced symptoms frequently or every time they had had intercourse in the last six months or more.

Around a third of these women said they were dissatisfied with their sex life, compared with one tenth of the women who didn’t report painful sex.

Lead researcher, Dr Kirstin Mitchell, from LSHTM and the University of Glasgow, the said there could be a whole range of reasons for dyspareunia.

“In younger women, it might be that they are starting out in their sexual lives and they are going along with things that their partner wants but they are not particularly aroused by.

“Or they might be feeling tense because they are new to sex and they are not feeling 100% comfortable with their partner.”

Painful sex might be caused by other health problems, such as sexually transmitted infections, endometriosis and fibroids, which should be diagnosed and treated.

Women around the age of the menopause can find sex painful because of vaginal dryness.

Dr Mitchell says it’s not just older women who can feel embarrassed talking about painful sex, even though the condition is common.

Healthcare professionals need more support in broaching the topic of dyspareunia – or painful sex – say researchers, who have found nearly one in 10 of UK women are experiencing it.

The findings come from the third National Survey of Sexual Attitudes and Lifestyles, which is the largest scientific study of sexual health lifestyles in Britain.

The national survey examined 8,869 women aged between 16-74 from 2010 to 2012. Among the 6,669 who had been sexually active in the past year, 7.5% reported having painful sex.

Of those, 1.9% experienced morbid pain – symptoms lasting at least six months and occurring very often or always and leaving the woman feeling distressed.

The proportion who reported painful sex was highest in women aged 55-64 and those aged 16-24.
Of the 1,708 women who were not sexually active, 2% said they avoided intercourse due to painful sex or a fear of feeling pain.

The researchers found painful sex was strongly associated with other sexual function problems, in particular vaginal dryness, feeling anxious during sex, and lack of enjoyment in sex.

It was also linked to poor physical and mental health including depression, sexual relationship factors, such as not sharing the same level of interest in sex, and adverse experiences, such as a sexually transmitted infection diagnosis and non-volitional sex.

Of those who reported painful sex, 31% said they were dissatisfied with their sex life, compared to 10% of women who did not report painful sex, while those experiencing pain were more likely to say they had avoided sex in the past year because of sexually difficulties.

Premature ejaculation refers to the inability of a man to delay ejaculation during a sexual act until their spouse has reached orgasm and are duly satisfied. By the way, it happens when a man releases or discharges after he has reached orgasm during a sexual encounter.

Many men are obviously unsure about how long a ‘normal’ sex should last before ejaculation. A study looking at 500 couples from many countries found the average time between when a man is putting his penis into his partner’s vagina and climaxing is eight-and-a-half minutes. Though there are no definitions of how long a sexual intercourse should last; nevertheless, ejaculating too quickly will not be a satisfying experience to the spouse.

The condition is so bad in some men that it happens every time they engage in lovemaking with their spouse such that their partner never reaches a climax. In some men, it’s even worse; they discharge even during foreplay, before they have had the time to penetrate the woman’s vagina. This has destroyed many marriages and put a big question mark on many sexual relationships.
Normally, depending on some circumstances and how they are handled, a man should be able to thrust in and out during the sexual act for ten or sometimes fifteen minutes.

Most men who suffer premature ejaculation come in the very first minute, leaving their partner unsatisfied and unfulfilled. This kind of condition should be a source of concern to a man because if this continues, it can throw the woman into sexual frigidity.

Premature ejaculation could either be lifelong or acquired.
In a case of lifelong premature ejaculation, the husband has been experiencing premature ejaculation since he started having intercourse. It means it has been present from the day he began sexual activity.
With acquired premature ejaculation, the husband in question previously had successful sexual intercourse and only now has developed premature ejaculation.

This suggests that it has not always been the case; it only resulted after a period of relative normal sexual functioning. Characteristics of husbands with lifelong premature ejaculation could include the following; psychological difficulties, deep anxiety about sex that relates to one or more traumatic experiences encountered during development.
Cases of acquired premature ejaculation can include the following: erectile dysfunction, performance anxiety, psychotropic drug use, etc.The challenge of early ejaculation has been divided into three parts.
Mild – occurring within approximately 30 seconds to one minute of vaginal penetration.
Moderate – occurring within approximately 15-30 seconds of vaginal penetration.
Severe – occurring before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration.

Premature ejaculation is believed to be a psychological problem and does not represent any known organic disease involving the male reproductive tract or any known lesions in the brain or nervous system.

Premature ejaculation is the most common sexual disorder in men younger than 40 years. It has historically been considered a psychological disease with no identified organic cause. The cause of premature ejaculation varies from one person to another. For a large majority of persons, it is lack of skills, being untrained in how to delay ejaculation.

Some persons are more physically sensitive than others. Just like when you tickle a fellow, some persons jump up that you almost wonder if they are only reacting to the tickle or something else. And then you tickle some other persons, they hardly move. We vary in the way we respond to external stimuli.

Some people who are very sensitive or extra sensitive to external stimulation will like suffer premature ejaculation, while people who are quite ‘numb’ will suffer it less. The problem of a percentage of people who suffer premature ejaculation is psychological. They only need a bit of a paradigm shift to do well in these circumstances.

When a husband does not know that his first purpose in the sexual act is to satisfy his wife, he will only mind satisfying himself. Such a man can be a victim of premature ejaculation because his mind is so occupied with his own satisfaction.
Every husband should understand that they have a duty during sex to satisfy their spouse.

Making love with your spouse and abandoning her halfway is irresponsible. So, a man should fix his mind on satisfying his spouse first before being satisfied – escorting his wife to orgasm first before getting climaxed. This mental shift will make the next few tips easy for every man to imbibe. Once again, it is out of place to climax in sex while your spouse has not reached orgasm.